Fill - Free fillable Verification of Service and Salary (Texas Real Estate Contracts) PDF form

1000 Red River Street

Austin, TX 78701-2698

(800) 223-8778

www.trs.texas.gov

Teacher Retirement System of Texas Page 1 of 3

Verification of Service and Salary

TRS22I (09-16)

Name

TRS Participant ID or

Social Security Number

Address

TRS MEMBER: This form is to be completed and signed by the current TRS reporting official or other appropriate

official of the Texas public educational institution where the service being verified was rendered. After the form has

been completed and signed by the reporting official, you must sign where indicated on page 3, before sending the

form to the Teacher Retirement System of Texas (TRS). See additional instructions on pages 2 and 3.

REPORTING OFFICIAL: Do not include more than one school year on this form. If more than one school year is being

verified, use a separate form for each year. Initial here _______ if more than one form is being completed. Please

complete all requested information; do not leave information blank. If records are unavailable or the information is

unknown, indicate in the space provided. Verification must be based on records created at or near the time of

service. An affidavit based on memory is not sufficient. After completing this page, read and sign the "Certification

of Reporting Official" on page 2. Note, your signature must be notarized. Return this form to the member after

completion. Do not return this form to TRS.

SECTION A: See instructions on page 2 before completing this section

1. School year during which service was rendered ________________________

2. Number of days worked or on paid leave ________________________

3. Gross salary paid for this period ________________________

4. Position or job title ___________________________

5. Member’s name at the time service was rendered __________________________

6. Was this service rendered as an employee or as an independent contractor? _____________________

SECTION B: See instructions on page 2 before completing this section.

1. Was employment for one-half or more of the standard workload? Yes No

2. Was the salary rate comparable to the rate of compensation paid to

other persons employed in similar positions at the time? Yes No

3. If the answer to question #2 in this section is “No”, was the person’s

customary employment for at least 20 hours per week, each week,

for a period of at least four and one-half months in one school year? Yes No

4. Employment dates for the first semester: Beginning Ending

Semester dates for the first semester: Beginning Ending

5. Employment dates for the second semester: Beginning Ending

Semester dates for the second semester: Beginning Ending

SECTION C: In addition to Sections A and B, this section must be completed if the service being verified was

rendered for a TRS-covered employer that is an institution of higher education. Leave this section blank if the

service being verified was rendered for a TRS-covered employer other than an institution of higher education.

1. Was the employment verified above contingent upon the person’s enrollment as a student in your institution?

Yes _____ No _____

2. Did the person named above participate in the Optional Retirement Program during the year listed?

Yes _____ No ______

1000 Red River Street

Austin, TX 78701-2698

(800) 223-8778

www.trs.texas.gov

Teacher Retirement System of Texas Page 2 of 3

Verification of Service and Salary

TRS22I (09-16)

INSTRUCTIONS FOR REPORTING OFFICIAL

This form must be completed and signed by the current TRS reporting official of the Texas public educational institution

where the service was rendered or by the public educational institution’s payroll manager, payroll supervisor, financial

officer, or superintendent. TRS may not accept the form if it is not signed by an appropriate official. All information in

Sections A and B on the front side of this form must be completed. In addition, Section C must be completed if the

service being verified was rendered in an institution of higher education. In all cases, the "Certification of School Official"

below must be completed. This form is not to be used to verify substitute service, worker’s compensation

payments, or out-of-state service.

Sections 825.403 and 825.505 of the Texas Government Code grant TRS the right to audit records used for

documentation of service and salary. By completing this form and signing the "Certification of Reporting Official," you

agree to produce the records used to verify the service and salary listed upon TRS’s request.

Verification must be based on records created at or near the time of service. An affidavit based on memory is not

sufficient.

CERTIFICATION OF REPORTING OFFICIAL: I certify that records created at or near the time of service in my office

show that the person named on this form performed the service listed on this form and show that all other information

provided in Sections A and B is true and correct. I further certify that I am currently employed by the TRS-covered public

educational institution named below. The public educational institution agrees to produce records used to verify the

service and salary reported to TRS upon request as required in Sections 825.403 and 825.505 of the Texas Government

Code.

Signature of TRS Reporting Official Title of Reporting Official Date

Printed Name of TRS Reporting Official Name of Texas Public Educational Institution Phone Number

NOTARIZATION OF REPORTING OFFICIAL SIGNATURE

STATE OF

COUNTY OF

Before me, a notary public, on ___________________ (date) personally appeared ____________________ (reporting

official) known to me to be the person whose name is subscribed to the foregoing document and, being by me first duly

sworn, declared that the statements therein are true and correct.

GIVEN under my hand and official seal this the ______________ day of __________, ___________. (SEAL)

Month Year

_________________________________________________

Signature of Notary Public

RETURN THIS COMPLETED FORM TO THE MEMBER. DO NOT RETURN THIS FORM TO TRS.

1000 Red River Street

Austin, TX 78701-2698

(800) 223-8778

www.trs.texas.gov

Teacher Retirement System of Texas Page 3 of 3

Verification of Service and Salary

TRS22I (09-16)

INSTRUCTIONS FOR MEMBER

Employment that is eligible for TRS membership is employment in a Texas public educational institution for at least

one-half the standard full-time work load, paid at a rate comparable to someone employed in a similar position. To

establish service credit, prior to the 2011-12 school year, a person must have served in an eligible position with an

eligible employer, for a period of at least four and one-half months, a full semester of more than four months, or, in some

circumstances, 90 days in one school year. For the 2011-12 and later school years, a member must work or be on paid

leave for at least 90 days in one school year to receive a year of service credit. In addition, if there is no equivalent

full-time position of a given position, the minimum number of hours required per week that will qualify the position for

TRS membership is 15. Take this form to the Texas public educational institution where you rendered the service being

verified for completion of Sections A, B, and C (if applicable) and the "Certification of Reporting Official." After the

reporting official has completed all information, sign below and return this form to TRS. TRS will determine, based on the

information provided by the reporting official and applicable laws and rules, whether eligible service is indicated. Receipt

of this form by TRS does not constitute a guarantee that service credit will be granted by TRS.

If TRS determines that the employment and/or compensation is eligible for TRS credit, TRS will send you a cost

statement for the amount due. All deposits and fees due for each year of service credit you wish to purchase must

be paid in full before this service or compensation can be used in the determination of your eligibility for

benefits and in the calculation of your benefits . The cost increases each year the amount due remains unpaid.

All unreported service rendered or compensation paid prior to September 1, 2011 must be verified no later than

September 1, 2016. Beginning with unreported service rendered on or after September 1, 2011 or unreported

compensation paid on or after September 1, 2011, verification must be received by TRS no later than five years after the

end of the school year in which the service was rendered or the compensation was paid. Service and/or compensation

that is not verified within the required timeframe will not be eligible for purchase and cannot be used in determining

eligibility for or the calculation of any benefits. Verification of unreported service and/or compensation cannot be

accepted after you have retired and TRS has issued your first retirement annuity payment.

I have read the "Instructions for Member" and understand that, if TRS determines that the service or compensation is

eligible for TRS credit, I will be required to pay any deposits and fees that are due if I want to have this service or

compensation included in the determination of my eligibility for and in the calculation of my benefits. I also

understand that it is the decision of TRS whether my service or compensation is eligible for TRS credit.

Signature _________________________________________________ Date ______________________

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